Investigating an Outbreak. Part I

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Investigating an Outbreak Principles of Epidemiology Lecture 8 Dona Schneider, PhD, MPH, FACE What is an outbreak? An epidemic or an outbreak exists when there are more cases of a particular disease than expected in a given area, or among a specific group of people, over a particular period of time. Epidemiology (Schneider) Endemic vs. Epidemic No. of Cases of a Disease Endemic Time Epidemic Epidemiology (Schneider) Why investigate outbreaks or epidemics?   Control and prevention Severity and risk to others Research opportunities to gain additional knowledge Training opportunities Program considerations     Public, political, or legal concerns Epidemiology (Schneider) Step 1: Verify the outbreak  Determine whether there is an outbreak – an excess number of cases from what would be expected Establish a case definition     Non-ambiguous Clinical / diagnostic verification Person / place / time descriptions  Identify and count cases of illness Epidemiology (Schneider) Step 2: Plot an Epidemic Curve  Graph of the number of cases (y-axis) by their date or time of onset (x-axis)  Interpreting an epidemic curve  Overall pattern: increase, peak, decrease   Type of epidemic? Incubation period? Unrelated? Early or late exposure? Index case? Secondary cases?  Outliers:    Epidemiology (Schneider) Vector-borne Disease • Starts slowly • Time between the first case and the peak is comparable to the incubation period. • Slow tail Point Source Transmission • This is the most common form of transmission in foodborne disease, in which a large population is exposed for a short period of time. Continuing Common Source or Intermittent Exposure • In this case, there are several peaks, and the incubation period cannot be identified. Salmonellosis in passengers on a flight from London to the United States, by time of onset, March 13--14, 1984 Source: Investigating an Outbreak, CDC Legionnaires' Disease By date of onset, Philadelphia, July 1-August 18, 1976 Source: Investigating an Outbreak, CDC Foodborne Outbreak (Propagated) Source: CDC, unpublished data, 1978 Step 3: Calculate attack rates Attack rate = (ill / ill + well) x 100 during a time period If there is an obvious commonality for the outbreak, calculate attack rates based on exposure status (a community picnic) If there is no obvious commonality for the outbreak, calculate attack rates based on specific demographic variables (hepatitis cases in a community) Epidemiology (Schneider) Step 4: Determine the source of the epidemic If there is an obvious commonality for the outbreak, identify the most likely cause and investigate the source to prevent future outbreaks If there is no obvious commonality for the outbreak, plot the geographic distribution of cases by residence/ work/school/location and seek common exposures Epidemiology (Schneider) Step 5: Recommend control measures Control of present outbreak Prevention of future similar outbreaks   Epidemiology (Schneider) The vast majority of outbreaks are food-borne Foodborne Disease Outbreak  An incident in which (1) two or more persons experience a similar illness after ingestion of a common food, and (2) epidemiologic analysis implicates the food as the source of the illness Intoxication – ingestion of foods with in tissues of certain plants (Jimpson Weed) and animals (seal liver) Metabolic Toxicants found products (toxins) formed and excreted by microorganisms while they multiply (botulinum toxin) Poisonous substances introduced during production, processing, transportation or storage (chemicals, pesticides) Foodborne Disease Outbreak (cont.)  Infections – Caused by the entrance of pathogenic microorganisms into the body and the reaction of the body tissues to their presence or to toxins they generate within the body  Rule of thumb – but not law  Intoxicants are rapid onset, no fever    Toxins in the stomach produce vomiting Toxins in the intestines produce diarrhea Infections produce fever Types of Foodborne Contamination  Physical  Glass, metal fragments, tacks, dirt, bone, etc.  Chemical  Pesticides, cleaning compounds, poisonous metals, additives and preservatives  Biological  Bacteria, viruses, fungi, yeast, molds, parasites, poisonous fish and plants, insect and rodents Epidemiology (Schneider) Bacterial Requirements  Food: Most bacteria require what is known as potentially hazardous food  Milk or milk products, eggs, meat, poultry, fish, shellfish, crustaceans, raw seed sprouts, heat treated vegetables and vegetable products (fruits?)  Generally high protein, moist foods Epidemiology (Schneider) Bacterial Requirements (cont.)  Water: Bacteria require moisture to thrive  The water activity (Aw) is the amount of water available in food The lowest Aw at which bacteria will grow is 0.85   Most potentially hazardous foods have a water activity of 0.97 to 0.99  pH: Best growth at neutral or slightly acidic pH  Potentially hazardous foods have a pH of 4.6 – 7.0 Epidemiology (Schneider) Bacterial Requirements (cont.)  Temperature: The danger zone for potentially hazardous foods is 45 to 140 degrees Fahrenheit  This is the zone where most bacterial growth occurs  Time: Potentially hazardous foods must not be allowed to remain in the danger zone for more than 4 hours Oxygen: Some bacteria require oxygen while others are anaerobic and others are facultative  Epidemiology (Schneider) Major Causes of Foodborne Disease   Improper cooling of foods Improper cooking of foods Improper reheating of foods Improper holding temperature of foods Cross contamination Infected food handlers, poor employee hygiene     Epidemiology (Schneider) 0F Temperature and Bacteria Control Canning temperatures for low-acid vegetables, meat, and poultry in pressure canner Canning temperatures for fruits, tomatoes, and pickles in waterbath canner 250 240 212 Water boils Most bacteria destroyed 165 No growth, but survival of some bacteria 140 DANGER ZONE Some bacterial growth; many bacteria survive 125 120 98.6 60 Hottest temperature hands can stand Extreme DANGER ZONE. Rapid growth of bacteria and production of poisons by some bacteria Body temperature – ideal for bacterial growth Some growth of food poisoning bacteria may occur Slow growth of some bacteria that cause spoilage Water freezes Growth of bacteria is stopped, but bacteria level before freezing remains constant and not reduced 45 40 32 0 - 20 Keep frozen foods in this range Source: Keeping Food Safe to Eat, USDA Bacterial Growth Curve Stationary Phase Log Phase Number of Cells Decline Phase Lag Phase Time Epidemiology (Schneider) Effect of Temperature in Salmonella Growth Number of Salmonella per gram 50oF (10o C) 95oF (35o C) 44oF (6.7o C) 42oF (5.5o C) 1 2 3 4 5 Days Epidemiology (Schneider) Incubation Periods 2-4 hours 12 hours Staphylococcus aureus Clostridium perfringens Cooked ham, meat, eggs, sauces and gravies Cooked meats, gravy 12-36 hours 12-36 hours Salmonella* Clostridium botulinum Meat, poultry, eggs Canned foods, smoked fish 12 hours 24-48 hours Vibrio parahemolyticus* Shigella* Raw fish, shellfish Contaminated by carrier, not foodborne * Fever National Data on Etiology of Foodborne Illness Agent Bacteria (40 agents) Salmonella Staph. aureus 68.7% 25.0% 12.7% Clostridium perfringens Clostridium botulinum Viral (11 agents) Parasites (31 agents) Fungal (16 agents) 10.0% 9.5% 9.4% 0.5% 1.8% Plants (36 agents) Fish (28 agents) Chemicals (28 agents) 12.3% 7.3% Investigating an Epidemic: Oswego, NY On April 19, 1940, the local health officer in the village of Lycoming, Oswego County, New York, reported the occurrence of an outbreak of acute gastrointestinal illness to the District Health Officer in Syracuse. Dr. A. M. Rubin, epidemiologist-in-training, was assigned to conduct an investigation. When Dr. Rubin arrived in the field, he learned from the health officer that all persons known to be ill had attended a church supper the previous evening, April 18. Family members who had not attended the church supper had not become ill. Accordingly, the investigation was focused on the circumstances related to the supper. Source: CDC Interviews regarding the presence of symptoms, including the day and hour of onset, and the food consumed at the church supper, were completed on 75 of the 80 persons known to have been present. A total of 46 persons who had experienced gastrointestinal illness were identified. Q: Is this an Epidemic? Endemic for the region? Due to seasonal variation? Due to random variation? Epidemiology (Schneider) Select the correct case definition and find the error in the others: 1. All participants in the Oswego church supper held in the basement of the church in Lycoming, Oswego County, New York, on April 18, 1940, between 6:00 PM and 11:00 PM; whether they attended church or not; whether they participated in food preparation, transport, or distribution or not; whether they ate or not. Persons who developed acute gastrointestinal symptoms within 72 hours of eating supper on April 18, 1940, and who were among attendees of the Lycoming, Oswego Church supper. Church members who developed acute gastrointestinal symptoms within 72 hours of the church supper held in Lycoming, Oswego on April 18, 1940. 2. 3. Select the correct case definition and find the error in the others: 1. All participants in the Oswego church supper held in the basement of the church in Lycoming, Oswego County, New York, on April 18, 1940, between 6:00 PM and 11:00 PM; whether they attended church or not; whether they participated in food preparation, transport, or distribution or not; whether they ate or not. Persons who developed acute gastrointestinal symptoms within 72 hours of eating supper on April 18, 1940, and who were among attendees of the Lycoming, Oswego Church supper. Church members who developed acute gastrointestinal symptoms within 72 hours of the church supper held in Lycoming, Oswego on April 18, 1940. 2. 3. Select the correct case definition and find the error in the others: 1. All participants in the Oswego church supper held in the basement of the church in Lycoming, Oswego County, New York, on April 18, 1940, between 6:00 PM and 11:00 PM; whether they attended church or not; whether they participated in food preparation, transport, or distribution or not; whether they ate or not. Missing definition of sickness Persons who developed acute gastrointestinal symptoms within 72 hours of eating supper on April 18, 1940, and who were among attendees of the Lycoming, Oswego Church supper. CORRECT Church members who developed acute gastrointestinal symptoms within 72 hours of the church supper held in Lycoming, Oswego on April 18, 1940. Did not specify that they went to the dinner 2. 3. Incidence of Cases of Diarrhea Among People Attending Lycoming,Oswego Church Supper, June 1940 The supper was held in the basement of the village church. Foods were contributed by numerous members of the congregation. The supper began at 6:00 PM and continued until 11:00 PM. Food was spread out upon a table and consumed over a period of several hours. Epidemiology (Schneider) Church Supper Menu Main Dishes • • • • • • • • • • • • • • Baked ham Spinach Mashed potatoes Cabbage salad Fruit Salad Jello Rolls Brown Bread Cakes Vanilla Ice Cream Chocolate Ice Cream Milk Coffee Water Side Dishes Desserts Beverages Epidemiology (Schneider) Which menu item(s) is the potential culprit? To find out, calculate attack rates. The foods that have the greatest difference in attack rates may be the foods that were responsible for the illness. Epidemiology (Schneider) Attack Rates by Items Served: Church Supper, Oswego, New York; April 1940 Number of persons who ate Ill 29 specified item Well Total Attack rate (%) 17 46 Number of persons who did not eat specified item Ill 17 Well 12 Total 29 Attack rate % Baked ham Spinach Mashed potato 26 23 17 14 43 37 20 23 12 14 32 37 Cabbage salad Jello Rolls 18 16 21 10 7 16 28 23 37 28 30 25 19 22 13 47 52 38 Brown bread Milk Coffee 18 2 19 9 2 12 27 4 31 28 44 27 20 27 17 48 71 44 Water Cakes Ice cream (van) 13 27 43 11 13 11 24 40 54 33 19 3 18 16 18 51 35 21 Ice cream (choc) Fruit salad 25 4 22 2 47 6 20 42 7 27 27 69 Epidemiology (Schneider) Attack Rates by Items Served: Church Supper, Oswego, New York; April 1940 Number of persons who ate Number of persons who did not eat specified item Ill 17 20 Well 12 12 Total 29 32 Attack rate % 59 62 specified item Ill 29 26 Well 17 17 Total 46 43 Attack rate (%) 63 60 Baked ham Spinach Mashed potato Cabbage salad Jello 23 18 16 14 10 7 37 28 23 62 64 70 23 28 30 14 19 22 37 47 52 62 60 58 Rolls Brown bread Milk 21 18 2 16 9 2 37 27 4 57 67 50 25 28 44 13 20 27 38 48 71 66 58 62 Coffee Water Cakes 19 13 27 12 11 13 31 24 40 61 54 67 27 33 19 17 18 16 44 51 35 61 65 54 Ice cream (van) Ice cream (choc) Fruit salad 43 25 4 11 22 2 54 47 6 80 53 67 3 20 42 18 7 27 21 27 69 14 74 61 Attack Rates by Items Served: Church Supper, Oswego, New York; April 1940 Number of persons who ate Ill Baked ham Spinach Mashed potato Cabbage salad Jello Rolls 29 26 23 18 16 21 specified item Well Total Attack rate (%) 17 17 14 10 7 16 46 43 37 28 23 37 63 60 62 64 70 57 Number of persons who did not eat specified item Ill 17 20 23 28 30 25 Well 12 12 14 19 22 13 Total 29 32 37 47 52 38 Attack rate % 59 62 62 60 58 66 Brown bread Milk Coffee 18 2 19 9 2 12 27 4 31 67 50 61 28 44 27 20 27 17 48 71 44 58 62 61 Water Cakes Ice cream (van) 13 27 43 11 13 11 24 40 54 54 67 80 33 19 3 18 16 18 51 35 21 65 54 14 Ice cream (choc) Fruit salad 25 4 22 2 47 6 53 67 20 42 7 27 27 69 74 61 Highlighted row indicates largest difference between attack rates Attack Rate by Consumption of Vanilla Ice Cream, Oswego, New York; April 1940 Ill Ate vanilla ice cream? Yes No Total Well 11 18 29 Total 54 21 75 Attack Rate (%) 79.6 14.3 61.3 43 3 46 • • The relative risk is calculated as 79.6/14.3 or 5.6 The relative risk indicates that persons who ate vanilla ice cream were 5.6 times more likely to become ill than those who did not eat vanilla ice cream Conclusion  An attack of gastroenteritis occurred following a church supper at Lycoming The cause of the outbreak was most likely contaminated vanilla ice cream  Epidemiology (Schneider) Surveillance Ongoing systematic collection, collation, analysis and interpretation of data; and the dissemination of information to those who need to know in order that action may be taken. World Health Organization Epidemiology (Schneider) Purposes of Public Health Surveillance          Estimate magnitude of the problem Determine geographic distribution of illnesses Portraying the natural history of disease Detect epidemic / Define a problem Generate hypotheses and stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practice Facilitate planning CDC Epidemiology (Schneider) Passive Surveillance  Physicians, laboratories, and hospitals are given forms to complete and submit with the expectation that they will report all of the cases of reportable disease that come to their attention Advantages: Inexpensive   Disadvantages: Data are provided by busy health professionals. Thus, the data are more likely to be incomplete and underestimate the presence of disease in the population Epidemiology (Schneider) Active Surveillance  Involves regular periodic collection of case reports by telephone or personal visits to the reporting individuals to obtain the data  Advantages: More accurate because it is conducted by individuals specifically employed to carry out the responsibility Disadvantages: Expensive  Epidemiology (Schneider) Sentinel Surveillance  Monitoring of key health events, through sentinel sites, events, providers, vectors/animals  Case report indicates a failure of the health care system or indicates that special problems are emerging Advantages: Very inexpensive Disadvantages: Applicable only for a select group of diseases   Epidemiology (Schneider) Some Surveillance Programs  National Notifiable Diseases Surveillance System http://www.cdc.gov/epo/dphsi/nndsshis.htm  Morbidity and Mortality Weekly Report (MMWR) http://www.cdc.gov  Cancer Surveillance, Epidemiology and End Result (SEER) http://www.seer.cancer.gov/ Epidemiology (Schneider) “Good surveillance does not necessarily ensure the making of right decisions, but it reduces the chances of wrong ones.” Alexander D. Langmuir NEJM 1963;268:182-191 Epidemiology (Schneider)

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